Ch 5: Parkinson's Disease
|Parkinson's Disease Etiology||a hypokinetic CNS movement disorder that is idiopathic, slowly progressive, and degenerative.|
|Symptoms||begins with a resting "pill rolling" tremor of one hand, cardinal signs include: tremor, rigidity, resistance to passive motion that is not velocity dependent (cogwheel or lead pipe), akinesia, postural instability, festinating gait, falling backwards (retropulsion) or fowards (propulsion) mask face, micrographia|
|Postural abnormalities associated with PD include:|| • Flexed, stooped postured with the head position forward. |
• Balance reactions are compromised, PD persons experienced frequent falls
|Stage I||unilateral tremor, rigidity, akinesia, minimal or no functional impairment.|
|Stage II||bilateral tremor, rigidity, akinesia, with or without axial signs, independent with ADL, no balance impairment.|
|Stage III||worsening of symptoms, first signs of impaired righting reflexes, onset of disability in ADL performance, can lead independent life.|
|Stage IV||requires help with some or all ADLs. unable to live alone without some assistance, able to walk and stand unaided.|
|Stage V||confined to a wheelchair or bed, maximally assisted.|
|Evaluation:||• PD's symptoms in individual clients have been measured using the Unified Parkinson's Disease Rating Scale: this scale evaluates a client's motor skills, functional status, and extent of disability. |
• Client interview to measure functional statues and extent of disability, addressing ADLs skills and cognitive and emotional factors.
|Treatment Medical Management||Surgical interventions and medications (Levodopa, sinemet, dopamine agonists, anticholinergics for rigidity and tremors, and dopamine releasers|
|side effects due to medication||hallucinations, a drop in blood pressure when standing (orthostatic hypotension), and nausea|
|Treatment OT perspective||Occupational therapy can help people with Parkinson's disease stay active in daily life. By improving pt. ADLs, showing pt. different ways to complete tasks, or introducing pt. to assistive devices. May also recommend home or work modifications.|
|Role of Occupational Therapist||• Compensatory strategies, client and family education, environmental and task modifications, and community involvement.|
• Client education and significant others regarding the course of the disease.
• Information should be provided to the client and family members about community resources and support groups.
|Modification of household items during early stages of PD:||1. Use of built-up handles for eating and writing utensils should be introduced.|
2. Paying bills, signing forms or doing other written work should be completed soon after taking levodopa.
3. Loose rugs should be removed from floors and furniture should be placed close to the wall to decrease obstacle.
4. Chairs with armrest
5. Bath and toilet railings and a raised toilet seat should be provided within the home.
6. Rocking motion to begin movement activities
|Last Stages Intervention:|| • Home environment modification for access and control|
• Use of environmental control units: switch-operated television or radio can be useful.